Cladribine Totally Explained

Everything about Cladribine totally explained

Cladribine is a drug commonly used to treat hairy cell leukemia (leukemic reticuloendotheliosis). Its brand name is Leustatin, and it's commonly referred to as 2CDA.
A purine analog, it's a synthetic antineoplastic agent with immunosuppressive effects. Chemically, it mimics the nucleoside adenosine and thus inhibits the enzyme adenosine deaminase, which interferes with the cell's ability to process DNA. It is easily destroyed by normal cells in the body except for blood cells, with the result that it produces relatively few side effects and results in very little non-target cell loss.

Indications

Cladribine is indicated for the treatment of symptomatic hairy cell leukemia (HCL).
It is under investigation for other B cell leukemias and lymphomas, such as mantle cell lymphoma, and for multiple sclerosis.
According to the Histiocytosis Association of America, cladribine is used to treat histiocytosis.

Routes of administration

For hairy cell leukemia, cladribine can be given by IV infusion or subcutaneous ("sub-q" or SQ) injection.
   For outpatient IV infusions, the delivery time (not including time to place the IV line) may range from one to four hours; two hours is most common. Continuous IV infusion may be chosen; this approach drips in the cladribine slowly, 24 hours a day using a portable pump and a central venous catheter or a PICC line. By contrast, SQ injections take less than ten seconds per day.
   The same total doses are given by both routes. IV and SQ routes have the same overall outcomes, and the SQ route may be reduce the infections and other risks associated with venipuncture.
   An oral pill form is being tested for multiple sclerosis.

Treatment schedule

Using either IV or SQ routes of administration, cladribine can be administered on a daily or a weekly schedule. Daily schedules involve one SQ injection or one IV infusion per day for five to seven consecutive days. Weekly schedules involve one injection or infusion each week, for five or six weeks. One cycle is normally sufficient to produce a complete response, but in the event of a partial response, cycles may safely be repeated one to three months after the end of the first cycle.
Actual doses are calculated according to the surface area of the patient's skin instead of by weight, and divided by the number of planned treatments.
All schedules produce the same benefits and disadvantages. Five-day and seven-day daily schedules give the same total amount of drug and have the same outcomes, including remissions and adverse effects. Daily and weekly schedules give the same total amount of drug and have the same outcomes, including similar proportions of complete responses and similar proportions of patients hospitalized for fevers and opportunistic infections.

Adverse effects

Among hairy cell leukemia patients, about half have no significant side effects from this treatment.
   Most other patients have a high fever that's caused by cancerous and non-cancerous white blood cells dying from the drug. As patients are at risk, from the disease as well as from the drug, for infections, most physicians give antibiotics to all patients with this fever just in case the fever is caused by a sudden infection instead of from the drug. Persistent fevers late in treatment are much more likely to be caused by infection.
   Existing studies estimate that from 18% These fevers resolve in less than 48 hours, have no evidence of being related to infection. However, some patients have fevers that last longer and may be caused by an infection. The use of these expensive drugs doesn't reduce the number of patients who experience fevers, the number of days that the fevers last, or the number of patients admitted to the hospital for antibiotic treatments.
   Some HCL patients will require blood transfusions of platelets or packed red blood cells. the median time to normalization of blood counts in patients with hairy cell leukemia is: two weeks for platelets, five weeks for absolute neutrophil counts, eight weeks for hemoglobin, and nine weeks for a patient to have all three parameters normalized. Weeks are counted from the first day of treatment, and all patients were on a seven-day daily treatment schedule for these studies.

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